Chen Andrew T, Patel Ashaka, McKechnie Tyler, Lee Yung, Doumouras Aristithes G, Hong Dennis, Eskicioglu Cagla
Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
J Surg Res. 2022 Feb;270:221-229. doi: 10.1016/j.jss.2021.09.026. Epub 2021 Oct 25.
Traditionally, reversal of neuromuscular blocking agents following the completion of surgery was achieved with cholinesterase inhibitors. Recently, sugammadex has been increasingly relied upon. Sugammadex is a γ-cyclodextrin molecule that rapidly reverses steroidal neuromuscular blocking drugs. Its use following colorectal surgery has become more common, and while the rapidity of reversal is undoubtedly improved, whether sugammadex impacts clinical postoperative outcomes is unknown. This systematic review and meta-analysis aims to compare postoperative outcomes in patients receiving sugammadex to those receiving a control during colorectal surgery.
Medline, Embase, and CENTRAL were systematically searched. Articles were included if they compared sugammadex with a control (e.g., neostigmine, pyridostigmine, placebo) in patients undergoing colorectal surgery in terms of total hospital length of stay and frequency of postoperative adverse respiratory events. Pairwise meta-analyses using inverse variance random effects was performed.
From 269 citations, five studies with 535 patients receiving sugammadex (45.8% female; mean age: 64.4) and 569 patients receiving a control (45.0% female; mean age: 64.3) were included. There was no significant difference in length of stay between the two groups (MD -0.01, 95% CI -0.27 to 0.25, P = 0.95). The risk of adverse respiratory events postoperatively was similar between the two groups (RR 1.33, 95% CI 0.81-2.19, P = 0.25).
There are no current data to suggest an improvement in postoperative outcomes with the use of sugammadex in patients undergoing colorectal surgery. This study is limited by the number of included studies. Further prospective studies comparing sugammadex and a control in colorectal surgery is required.
传统上，手术结束后使用胆碱酯酶抑制剂来逆转神经肌肉阻滞剂的作用。最近，舒更葡糖钠的使用越来越多。舒更葡糖钠是一种γ-环糊精分子，可迅速逆转甾体类神经肌肉阻滞药物的作用。其在结直肠手术后的使用变得更加普遍，虽然逆转速度无疑有所提高，但舒更葡糖钠是否会影响临床术后结局尚不清楚。本系统评价和荟萃分析旨在比较结直肠手术中接受舒更葡糖钠的患者与接受对照治疗的患者的术后结局。
对Medline、Embase和CENTRAL进行系统检索。如果文章比较了舒更葡糖钠与对照（如新斯的明、吡啶斯的明、安慰剂）在结直肠手术患者中的总住院时间和术后不良呼吸事件发生率，则纳入研究。采用逆方差随机效应进行成对荟萃分析。
从269篇文献中，纳入了5项研究，其中535例患者接受舒更葡糖钠治疗（女性占45.8%；平均年龄：64.4岁），569例患者接受对照治疗（女性占45.0%；平均年龄：64.3岁）。两组之间的住院时间无显著差异（MD -0.01，95%CI -0.27至0.25，P = 0.95）。两组术后不良呼吸事件的风险相似（RR 1.33，95%CI 0.81 - 2.19，P = 0.25）。
目前尚无数据表明在接受结直肠手术的患者中使用舒更葡糖钠能改善术后结局。本研究受纳入研究数量的限制。需要进一步进行前瞻性研究，比较舒更葡糖钠与对照在结直肠手术中的效果。
